Generalized Anxiety Disorder Scale, Prognosis, and Treatment

(Part 1 of 2)

Generalized anxiety disorder (GAD) is a chronic condition, and clinicians should keep that in mind when evaluating and treating patients, Manish K. Jha, MBBS, Assistant Professor of Psychiatry at Center of Depression Research and Clinical Care at UT Southwestern Medical Center, Dallas, TX tells Heather Flint, senior digital managing editor, Psych Congress Network.

In this video, Dr Jha expands on his recent Psych Congress session titled, "Difficult-to-Treat Patients with Generalized Anxiety Disorder." He clarifies the prognosis of GAD, utilizing the GAD scale, and when to discontinue medication for patients in remission.

In the upcoming part 2, Dr Jha discusses his preferred nonpharmacological treatments for anxiety disorders.

Read the transcript:

Heather Flint:  Hello, Psych Congress Network. I'm here with Dr Manish Jha, and we are going to be discussing common questions that come up about generalized anxiety disorder. Dr  Jha, if you'd like to introduce yourself.

Dr Manish Jha:  Thank you so much, and please call me Manish. I'm an assistant professor of psychiatry at UT Southwestern Medical Center.

My work has focused on aspects of depression that are often overlooked, such as anxiety, irritability, and more recently, talking about the untreated burden of generalized anxiety disorder. [I’m] so happy to be a part of this conversation.

Flint:  We appreciate you being here, Manish. We are going to start out with a question. Can you clarify the prognosis of generalized anxiety disorder?

Dr Jha:  Great question, and it often comes up. I do start with reminding that the diagnosis of generalized anxiety disorder, the way it is currently conceptualized in DSM is that symptoms have to be present for 6 months or longer.

By the very definition, it's a chronic condition. We have to keep that in mind when we are evaluating and are working with our patients who have generalized anxiety disorder, that it may have a chronic course.

Even if symptoms improve early on quickly with treatment, the treatment may need to continue for some time, several months. Then, a careful assessment should be made before we decide to discontinue the treatment because it can come back again.

Flint:  Understandable. How long after remission of symptoms do you think we can try discontinuing the medication?

Dr Jha:  That's, again, a great question. Here, we go back again to the chronic nature of the illness and some information about previous experiences with the treatment.

If a person has been treated before, they were better for several months to years, discontinued, and symptoms came back again, that likely is an indication that they may require much longer-term treatment.

It is different from someone who, for example, this is the first instance they have had it, was detected quickly, initiated with a treatment, and had a robust improvement.

There, we may think of discontinuing after 6 months or a year, but again, using a measurement-based approach, where when we decide it's time to discontinue, we meet more frequently, we counsel about discontinuation symptoms, and then approach with the discontinuation.

What is missing is any organized research around it. We don't have good research to support what happens in the course of illness that after some time, if we discontinue, is relapse more likely or not? There has been research in depression [the] space, but there hasn't been in the generalized anxiety disorder.

Flint:  Interesting. You mentioned using a scale. What are your thoughts on using the GAD scale?

Dr Jha:  GAD scale is the 7-item generalized anxiety disorder scale, often called GAD-7. The first 2 items of it is often used as a screener for anxiety disorder also, so GAD-2, you would also often hear about it. How important [is it]? Every patient I see in my practice has to fill it out, irrespective of what condition they have.

Because anxiety is so common, so widely prevalent, it's good to have systematic assessment of that. We often realize that even though individuals may not be asking treatment for it, it may often exist there and is often associated with less likelihood of improving with currently available treatments.

Dr Manish Jha is an assistant professor of psychiatry at the Center of Depression Research and Clinical Care at UT Southwestern Medical Center, Dallas, Texas. He conducts clinical research that aims to identify the biological mechanisms of depression, anxiety, and related disorders to inform the development of novel treatments.

He received his medical degree from Maulana Azad Medical College in New Delhi, India, and completed his residency training in Psychiatry at UT Southwestern Medical Center, Dallas, Texas. He is a member of the Society of Biological Psychiatry, American Society of Clinical Psychopharmacology, and an active member of the scientific community. In addition to his research and educational activities, Dr Jha maintains an active clinical practice focusing on evidence-based interventions for difficult-to-treat depressive and anxiety disorders.